|
BUILDING. INSPECTOR RECORD
<br />SITE.WORK D4TE'tD/stG.COMMENTS OTINEX BUILDER DELCANATION
<br />I hctchy aliirfl undcr lcn.lry oI lcrjury thd I cx.nu lmnr rh. ConhdoB Liccnsc tjw ln rhc folk,sin8 ,cas. (scc 70ll 5
<br />Businc$ lrn Pr.Icssion C.dc): Any Ciry or Counry wni.h rcqutcs 0 rEnnir lo ronnod. Dhcr. inTrolc. dd nish or tr'n my
<br />stru.rrc. prior ro n\ issuaR., nl$rcquiRs rhc aptli.Dnr li su.hr.nnil io filca siSncd storcnrtrl lh hcorshc h liccNcd pururtrl
<br />k, rhc pr.vi\n,ns ofrlr Co krctn r l-i.cnscd ljw ((:hrpi.r 9. (innnrici'rt snh Sedion TIXD of Division I ol rhe lrusinc$ rnd
<br />Prolcsio.s Codc) or th.r lEorshe iscrcmfl Ihcrclionr&d rhc b$h r(tr rh! nllcBcdcxcr,flion AnyriolalionoaSecrioiT0:rl5byany
<br />lllpliclnr laraI,€mil suhj(ls lhc applicrnr ro !civilpcnlhyolnol nMc lhrn nr. hond!.ddollai\ (S5m)
<br />l.$ owndurrhcprutl.ny,ornryemployccswirhs{rcsasrhrnv,b.o.rr.nrarion.*illdothcq'o.k rlltcsrtrl!ruismn
<br />i'nc'rlcd or orleFd for slc ( Sa 7l!t, Businc$ Md |rdtsi.trs Codc TIE Conklcrois l-iccn* LrN docr nor +Fl, ro an osm. ol
<br />rhcrnJEn! wh. huildr or nun^s rh.ren. rlwh)do6sud*od{hin$cllorlrncllorrhr.ugirhisorhcrownen,ployccs.
<br />povidc.l rhar \uch imrn,vcmnrr rrcnor inrcndLrl orollIrd ft, \xlc. lf. lx,*cvcr, rhc buildirB or impn'vlNnr issold*ilhirotrc rrr
<br />nlconrrlclin.lhc owncr 3uitls willhovc rhc$ordctrolloinsth: hc or drc did fr,1 h'ild or improlc rhc tmr.ny for ih. N4Fs of
<br />L alo*nerorrhcpnpcny, amcich\ie.lycontacriDs wirh liccnscd conrrmhn h .onrrd.r ih.lnAr lsc. Tl)4,1.8u$cs
<br />ad lbfcsanCod. Thc Contdctn s Liccnsc Lrq dNs n.r .mly to an owm, o f lirot'cny *ho nuilh or iml,ovcs rhcrcon.
<br />and who contGcrs for such Dm]ccls wnh a Conrrucro(s) liccnscd lurru n,
<br />'he
<br />CoorEr,\ l,icns hw).
<br />-l
<br />rmcxcnr uMcr S.dio
<br />]IABTE&i:TAIIIENSAIAN
<br />OECI.AEAIION
<br />I hc,cny lllnD under Dcnallyofpcriuryonc ollhc rblk,wirE dcclmrnrns
<br />IhnvcaMwillnui ri rccnilic ..lconsctrlk)scll lnsurcfor*r cn conrrcnsrlion- !s nmvi cd lor hys..rion lT(r.frh.
<br />Itrhtr (ixlc, hr ih. lcrf.nn c. ol ihc w6lk forwhich rhcFnnir ir i\surl
<br />-lh0!c
<br />und willm0inr.in wollc6 compcnslrion insurumc. u\ rcquircd hy Sccin,n .l7m of rhc ,itxtr Crxld. fot rhc lElfimnnccr\f
<br />rh. $1 tn whi.htht pc,lnir i\ i\sldt My trorkcn' comp.nvl ion inslrJn.ccrtricr d'rlFli.ynun$.r m:
<br />Poticy Numbclr-Eipncc:
<br />I.cdilyrhrt inrhc p.rformm.ol rhc sork for qhichrhis l.rnir is nsucd,I \hrll nor cmploy.nynr6o0 in trny
<br />'nrnncrso s n) $€om subjcd lo lhc rorkd{ conDcnsarn,n hrs of Californi0, rnd rrrcc I hlr il I \h,!ld tEonf, \uhj.d o rh.
<br />*orkcrJ .o,ntEns.rio. povnions ofSccrion l7(xr oirh. tjhor Codc.l nrll. lonhwilh onply with rio$ F,vi\ion\
<br />WARNIN(;: FdluE (, srt *orkc6'..n{rn\rti(,n colcragc i\ uihwtul. Md qhdl suhj..l dn cnlplorcr Io oiminnl p.mhns rnd
<br />civil fincs up b ore hxndrcd rhournnd doll&s (S100.0O0). in addidn tu rhc co{ ol coalp.nsrtior. danra8cs a\ povid nnrhc
<br />DICI.AMIIQN
<br />I h.Dl,ydlt'n undcr p.mlry olFrJUry rhar I ad li(nrd undcr provi\ior ofCh{r$ 9 (cornmn.irrg wirh Sdion ?(xXD olDivhioi.l
<br />oi rhc susincss 0d Pmns\ionsCodc. ud nryliccne n h tull torcc ql ctlc.r
<br />t I l5
<br />AIIIIIANLDECIAAAIION
<br />I hcrc$yifimundcr,'enalry oi !.rjury onc olUc nnhrins d(lmrions:
<br />Dcnnnilion PcflnnlAst nos Norifictrtion ltdcrrl Rctul$lions (Titlc.l0. l,rn6)
<br />-Requt
<br />d htt.r olNoli6.olior
<br />-l
<br />eniiyrhut rhc icdcr rc8llarionsEgadinE ashcnosrcn vnlurc nor rrDlk,blc nr rhis pni.Jc.r
<br />-l
<br />.ca r! 0rr I hrvc rcrd rh$ nl'!lElrion and $r. rhd rhc rh,!r hfornurii'n i\ .otr(r l r3re t' (rnnply sirh rll Ciry . d ( ounry
<br />ordinaNcs md Srolc LaBs rclolins r. blinlirrs confiErion. md hcEhylurtn,izc rcprc*nrariv.\ t,rrhi\ ciryiDd Coutrry lo.lllcr upon lhe
<br />rh,c yltlp$o\c rcdr(rrJ Jrn,prnr lar l
<br />Ar0li0nl or AA.trl Signnlu.e
<br />in,w vi/
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framin g
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />4-')g 9-/8 ,4(zt 7)
<br />FINAL
<br />Certif icate of Occu anc
<br />Notes Remarks
<br />SLAB Floor
<br />Ext./lnt. Lath
<br />il
<br />EIC.
<br />:-*"'iiTii'ff
<br />IAISIAIqUQNIEIDIM;.AGENCI
<br />I h.ftby aflir u.d.rFnalryorFrjuryrh,l rhd. isrd,r$ru.ri.n hndingrB.n.y lor rhc pcrfornurcc olthcso,k rorwhichrhi p.mn is
<br />issucd (Scc.3l)97. Civ C )
<br />tf,trJris Nrmc:
<br />-
<br />tt
|